There is no evidence of auditory hallucinations or disturbances in his thought process

A 6-year-old boy is brought to the clinic because of poor school performance. The parents stress that the child is very hard-working and go on to add that the child may actually work “too hard.” He will only turn work in to the teacher if the margins of his writing are perfectly aligned. Additionally, the patient makes it a point to wash his hands after every paragraph that he writes.Standardized testingshowsthatheisaboveaverageintelligenceandhasnospecific weaknesses in any academic discipline. He has many friends and is always well behaved and friendlyinallsocialandacademicsettings.Onmentalstatusexamination,heisawell-related and friendly child, appearing his stated age. He appears happy and denies any suicidal or homicidal intent, ideation, or plan. When asked why he must perform his schoolwork in this manner, the patient replies, “I don’t know why. I know the other kids don’t, but I just have to.”

There is no evidence of auditory hallucinations or disturbances in his thought process. Which of the following is the most appropriate next step in management?

Place him in a special education setting

Prescribe a trial of a low dose of haloperidol

Prescribe a trial of methylphenidate

Recommend cognitive-behavioral therapy

Recommend increased strictness in the patient’s household